CASE STUDY OF HYPERTENSION

INTRODUCTION

"The past can never be affected, since the recollecting of it

is an element in shaping the future."
-Jeunes Bryte

Mankind is fighting against diseases from time when life on

earth had started. Till now we have controlled many diseases and
now we are new diseases whose prevalence was not much in
past.

Today, in world, most deaths are attributed to non-

communicable diseases like cardiovascular diseases, mental illness
etc. Among cardiovascular diseases, “HYPERTENSION” is one of the
chronic non-communicable diseases, responsible for causation of
coronary heart disease, stroke and other vascular complications. So
the control of hypertension is much importance to us.

In lay man language, its only high level of blood pressure and
unfortunately high blood pressure is invariably not accompanied by
symptoms and therefore its detection and management is a
challenge. This is fact, why it has been described as a "Silent Killer".

Definition:-
According to WHO, a person having systolic blood pressure
≥160mmHg and/or diastolic blood pressure ≥95mmHg is said to
have hypertension.
According to Joint National Committee V and International
Society of hypertension, “Blood pressure ≥140mmHg systolic and
≥90mmHg diastolic is called hypertension.”

Classification:-
Hypertension can be classified in various ways,
A. According to causation.
1. Essential Hypertension, in which causes are
generally unknown & are responsible for
90% of all causes.
2. Secondary hypertension, in which some
other disease or abnormality is responsible
in its causation, like, diabetes mellitus,
Cushing syndrome, kidney diseases, etc.
B. According to Blood pressure measurement: - According to level of
blood pressure, category of hypertension is decided. Most
commonly we are considering WHO criteria for diagnosis,
which we will discus later in Methodology.
C. Classification by JNV-VII :-
Category Systolic BP(mmHg) Diastolic
BP(mmHg)
Normal ≤120 ≤80
Pre- hypertension 120-139 80-89
Hypertension- 140-159 90-99
Stage -1
Hypertension- ≥160 ≥100
Stage -2
Diagnosis:-
It is done by measuring the blood pressure with the help of
mercury manometer. But due to subjective variations, anxiety, fear,
inexperienced interpretation of korotkow sound, faulty instrument
etc, errors occur. So, WHO study group has mentioned standard
method of measuring BP.
Standard method of measuring BP-
1. Position of patient – sitting position.
2. Position of mercury manometer – at the level of patient’s
heart.
3. Arm to be used – In any arm, but clinic policy must be
uniform.
4. It should be measured at least 3 times over a period of 3
minutes & lowest reading is recorded.

From total number of cases of HT, only 50% are aware of this
condition & 25% are taking treatment regularly & only 12.5% cases
are controlled successfully. These figures vary from country to
country.
According to American Heart Association,
 One in 3 US adults has high Bp.
 28% of people with high BP don’t know that they have it.
 Among other who knows, 64.9% do not have it controlled.

Statistics:-
Hypertension is a major health problem in world. To reveal it
incidence has limited value because of variability in reading of an
individual.

Prevalence:-
In industrialized countries 25% of adults and in developing &
European countries 20% of adults are affected.
Prevalence is high in U.S. blacks, Russia, Finland (30-40%),
usual in Europe, Japan, U.S. whites (15-30%), low in rural Africa,
south china (7-15%).
And absent in Yanomani, Paeitic Island.
In India, urban areas prevalence rate is 164.18/1000 & in rural
areas prevalence rate is 157.44/1000. More incidences are found in
males than in females.

Mortality: - 20-50% of total death occurs due to hypertension.

In India, 91 deaths/hour occur due to cardiac diseases in
which one of the major risk factor is hypertension.
High blood pressure killed 54.19 people in the United
States in 2004. It was listed as a primary or contributing cause of
death in about 277000 U.S. deaths in 2004. (Ref. American Heart
Association)
This is why identification of risk factors & prevention is
necessary to stop this slow epidemic.
Risk factors associated with hypertension:-
Classified in 2 groups.
1. Non-modifiable risk factors like, age, gender, genetic
inheritance etc.
2. Modifiable risk factors like obesity, smoking, high salt intake,
stress, faulty diet, alcohol consumption, life style etc.

Preventive measures include regular exercise, restriction of

salt intake & avoidance of alcohol and smoking, weight control &
early detection and treatment.

METHOD OF STUDY
Case study is a good tool for understanding a disease in
community medicine. It not only guides us for scientific methods
of prevention but also tells about social, economical, cultural,
moral factors which might interfere in control measures.

Aims of case study on hypertension:-

 To know the pattern, presentation and progress of
hypertension.
 To understand effect & risk factors of hypertension.
 To establish control measures for hypertension.

Objective of case study on hypertension:-

 To understand effect of hypertension on patients life.
 To determine risk factors of hypertension present in
particular case.
 To find out any other member of patient’s family suffering
from hypertension.
 Establish integrated approach to control hypertension.

Case selection:-
This study was conducted in group & we were allotted
subject of hypertension. We selected one patient who had
essential hypertension. We got her from our hospital.
We conformed that she’s living within limits of Baroda city
as we had given limitation of travel expenditure from
department & she is co-operative.

Processes in study:-
We visited patient’s house, met her family & following steps were
taken.
 History taking & examination of patient to confirm
diagnosis.
 Family health checks up.
 Detailed study of diet of patient & her family.
 Study of housing, environment & sanitation.
  Socio-economic states of patient.
 Advised her for controlling the disease.

Regarding the visit:-

Visit 1 – we visited patient’s house on with our teacher

and guide Dr. Prakash Vaghela.
 There we took detailed history of patient & did whole
family health check up & inquired about diet & social
and economical states of family.
 In diet, we used questioners’ method to get data &
asked them about their menu, amount of food required
per month, method of cooking etc.
 In family health check up, we measured vitals of
members and did general examination of them.
 We inquired about housing & sanitation in details. We
had asked about water supple, latrine, urinal sewage,
disposal facility, noise pollution etc.
Visit 2 – dated on
 We inquired about their weekly diet and collected all
data for calculation of nutritional status.
 We again asked some questions on topics of previous
visit to solve some confusion.
Visit 3 – dated on
 We had advised patient about his condition & informed
her family about control measures of hypertension.

Thus, we had visited the patient 3 times to collect data for

satisfactory case study & patient gave us co-operation.

“Attempt the end & never stand to doubt, nothing so hard

but search will find out.”
- Robert Harrick

THANK YOU